WoundsWest: Delivering comprehensive strategies to improve wound ...

Prentice JL, Strachan V, Carville K, Santamaria N, Elmes R & Della P

WoundsWest: Delivering comprehensive strategies

WoundsWest: Delivering comprehensive strategies to improve wound management in Western Australian Health Services Prentice JL, Strachan V, Carville K, Santamaria N, Elmes R & Della P Abstract It is well known that prudent, supported, early discharge of patients back to their home environment facilitates recuperation, rehabilitation or palliation. Patients with wounds are no exception to this. The provision of effective ambulatory wound care is gaining increasing attention and importance worldwide as health services seek to provide efficient and effective services to growing numbers of patients with wounds, often under burgeoning fiscal constraints. The lack of, or poor utilisation of, evidence-based clinical practice guidelines and protocols for wound care and inequities in terms of access to resources, whether wound dressings or education, are causal factors leading to inconsistencies in the clinical management of wounds that contribute to less than optimal outcomes for patients with wounds. Health services and health managers' ability to strategically plan and rationalise wound management services is often further hindered by a lack of data on the epidemiology and potential burden of acute or chronic wounds within and on local or state health services. Furthermore, where there is an absence of clinical governance in relation to wounds, these wounds are not subject to the same scrutiny as other medical conditions and, therefore, opportunities to improve service delivery in relation to wound management are missed. This article describes a tripartite and multidimensional approach to providing West Australian public health services and employees with a sustainable system for the prediction, prevention and management of wounds. WoundsWest (WW), a partnership between WA Department of Health (WA Health), Silver Chain Nursing Association (Silver Chain) and Curtin University of Technology (Curtin University) is a novel, 6-year project and a first for Australia. WW aims to facilitate clinical governance of wounds within health services, enhance clinicians’ knowledge, skill and competence in wound management, improve clinical outcomes for patients with wounds and increase health services' ability to decrease the burden of wounds in Western Australian public hospitals. In order to achieve these aims, WW established a number of subprojects to ascertain the prevalence of wounds within WA public hospitals, improve access to educational resources for wounds, improve access to expertise in wound management and provide a repository for wound-related data for the purpose of ongoing research.

Introduction

been commissioned by Dr Phillip Della, then chief nursing and midwifery officer for WA Health and the Office of Safety

WoundsWest: The vision

and Quality, to undertake a literature review describing the

The genesis of WoundsWest (WW) was multifactorial as

problem of pressure ulcers in Australian healthcare settings

large projects often are. In 2006, Dr Shirley Bowen, director

with a view to improving pressure ulcer prediction and

of Ambulatory Care, North Metropolitan Area Health Service

prevention in WA. Following further discussion between

West Australian Department of Health (WA Health) contacted

all parties, it was agreed that duplication of effort should be

key individuals in WA with an expressed interest in wounds

avoided. Secondly, it was identified there was a dire need

(Santamaria, Prentice and Carville) to discuss investigating

to simultaneously categorise and quantify the burden of

pressure ulcer prevalence in West Australian (WA) hospitals;

wounds within WA’s public hospitals as other wounds, not

the aim being to reduce the overall prevalence of these wounds,

just pressure ulcers, impact on patterns of episodes of care,

particularly hospital acquired prevalence. Coincidentally, the

inclusive of length of stay and movement between public

PRIME Consortium (Santamaria, Prentice and Carville) had

and other health services, all of which have connotations for

Wound Practice and Research

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Volume 17 Number 3 – August 2009


health service planning, costs of care and resources required

into a 6-year project in November 2008 and will now conclude in October 2012. Financially, WW is supported by an annual budget of approximately $1m; $850k from WA Health and $150k from the Chief Nurse and Midwifery Office.

to manage patients with wounds. Dr Bowen submitted a proposal for a 3-year statewide programme for wound management to be known as ‘WW’ to

Silver Chain and Curtin University provide in-kind support through personnel and physical resources to each of the subprojects. For instance, Silver Chain has facilitated the hiring of project staff, the use of mobile phone audit tool technology, hosting of wound prevalence survey data, use of education materials on wounds, validation of the STAR Tool during wound prevalence surveys and establishment of the 1300 WOUNDS Call Centre for the WW Advisory Service.

the WA Health State Health Executive Forum (SHEF), which was duly accepted in November 2006. WW is a partnership between WA Health, the Silver Chain Nursing Association (Silver Chain) and Curtin University of Technology (Curtin University) under the auspices of Public Health, Ambulatory Care and Chronic Disease Management Reform, North Metropolitan Area Health Service. While sanctioned initially as a 3-year project, WW was expanded

Curtin University has provided temporary accommodation for project officers, third-year nursing students for two wound prevalence surveys and access to media students who assist with the development of interactive animations fundamental to the development of WW’s online education programme.

Dr Jenny Prentice * Project Director WoundsWest, Public Health and Ambulatory Care, Department of Health Western Australia 54 Salvado Road Wembley WA Tel: 08 9380 7720 Fax: 08 9380 7730 Email: [email protected]

Concept and philosophy of WW The initial concept, philosophy and underlying objectives of WW were to broadly: examine the epidemiology of wounds in WA public hospitals; introduce an online education programme on wound management; establish a longitudinal electronic patient record encompassing digital images of wounds; and to establish a data repository.

Veronica Strachan Program Manager National Health Workforce Taskforce, Melbourne VIC (Project Director WoundsWest, November 2006 to December 2008)

The philosophy and rationale behind these objectives was the perceived absence of any overarching sense of accountability for, or clinical governance of, wounds within WA Health, based on the following factors:

Keryln Carville RN, STN (Cred), PhD Assoc Professor Domiciliary Nursing Silver Chain Nursing Association & Curtin University of Technology

• The epidemiology, classification and number of wounds and their effect on health service delivery was unknown in WA.

Professor Nick Santamaria

• Fragmented wound management due to poor continuity of wound care and variations in clinical practice between clinicians and across health jurisdictions.

Chair of Acute & Ambulatory Care School of Nursing and Midwifery Curtin University of Technology

• Equity and access to wound care, wound care products and pressure reducing or relieving devices differed between metropolitan and country health services.

Ros Elmes Executive Director Public Health and Ambulatory Care, Department of Health Western Australia,

• Wound healing rates are not tracked, benchmarked or accurately costed.

Professor Phillip Della Head of the School of Nursing and Midwifery, Faculty of Health Sciences, Curtin University of Technology

• Wound management education and clinical guidelines are not readily accessible to all clinicians. • Inappropriate use and wastage of clinical resources such as dressings, devices and diagnostic investigations.

* Corresponding author



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• Wound documentation systems lack uniformity among health services.

WA Health with sustainable strategies for improving the

• Few health services applied national patient safety and quality indicators for preventable wounds such as pressure ulcers and skin tears.

As a result, WW and WA Health would expect, over time, to

delivery of wound management services.

see a number of improvements inclusive of reduced rates of iatrogenic pressure ulcers and skin tears, improved equity and access to wound management resources, reductions in

• Wound research locally was hampered by the lack of available data.

inappropriate transfer, presentation and admission of patients with wounds to tertiary facilities through better community

Individually and collectively the above factors lead to poor patient and health service outcomes, which affect the broader WA and Australian communities at large.

management and improved wound healing outcomes. Such improvements, if realised, would contribute to a reduction in the overall burden of wounds and reduce health service expenditure on wounds that could be redirected to other

Whilst some descriptive data exists pertinent to wounds in WA public health facilities data collected relates to specific wound categories such as pressure ulcers 1-4, leg ulcers 5, burns 6 or skin tears 7. Prior to the WW wound prevalence surveys no data described the burden of wounds within WA public health facilities upon which comprehensive strategies for statewide improvements in wound care could be based.

areas of health service need in WA.

Project aims and objectives The WW project aims to provide: 1. Healthcare practitioners in WA with an evidence-based, sustainable, statewide system for the prediction, prevention and management of wounds to provide optimum patient and health service outcomes.

Australian research has demonstrated that the implementation of clinical practice guidelines and standards for wound management, education and remote referral, coupled with evidence-based wound management, can reduce the prevalence of wounds, improve healing outcomes and reduce costs. In 2000, Prentice demonstrated the effectiveness of implementing clinical guidelines in conjunction with an intensive education programme in reducing pressure ulcer prevalence in selected tertiary hospitals across Australia 8. In Victorian public hospitals, pressure ulcer prevalence was reduced by 30% through the implementation of recommendations arising from three consecutive annual prevalence surveys 9-11. Similarly, the PRIME Consortium’s multi-centred study across Australia, using guidelines, education and digital imaging of pressure ulcers obtained a 40% reduction in pressure ulcers in residential aged care facilities 12. These same principles, when applied to the management of patients with neuropathic foot ulcers in the Kimberley region of WA, plus remote staff having access to a nurse consultant with expertise in wound management, led to a significant decrease in lower limb amputations when compared to a control group 13.

2. Health consumers and the community with information on wound management in WA. Furthermore, WW aims to reduce the burden on hospital inpatient and outpatient wound-related services by: • Improving access and equity to evidence-based wound management education and clinical guidelines. • Influencing the reduction in the prevalence of preventable wounds, such as pressure ulcers and skin tears. • Demonstrating the improved use of evidence-based wound prevention and management guidelines, • Establishing minimum competency levels in wound management. In order to achieve the above aims the project was divided into four subprojects (A, B, C & D), which synthesise the main components, objectives and deliverables of the project: A. Survey: Undertake three, annual wound prevalence

WW sought to translate the experiences and evidence from these studies into a statewide initiative aimed at improving individual clinicians' and health services' ability to better manage patients with wounds. By using an integrated approach of auditing the magnitude of wounds, online education, electronic referral and advice and providing a pool of data for ongoing research purposes, WW would provide


surveys of patients within the WA public health sector inclusive of remote and rural facilities. B. Education: Development of online, evidence-based education programmes, clinical guidelines and the provision of clinical support for health professionals managing patients with wounds 124




Mrs Veronica Strachan from November 2006 to December

C. Information technology (IT): Development of an advanced digital wound imaging and documentation system, which allows remote electronic referral and consultation that interacts with multiple healthcare providers.

2008. The WW project plan broadly: • Details the scope, planning, implementation and

D. Data repository: Establish a centralised data repository for storing WW data.

deliverables of the project. • Establishes a common understanding of the project

The specific objectives of each subproject are identified in Table 1.

objectives and deliverables. • Establishes resource requirement and commitments.

Project methodology

• Identifies project control mechanisms.

The WW project methodology is founded on a collaborative ‘Plan – Do – Study – Act’ approach (Shewart/Deming Cycle) 14.

• Clarifies

responsibilities,

accountabilities

and

authorities’ of those involved in the project.

Planning: has involved the development of project plans for each subproject that clearly articulate the scope, inclusions, exclusions, assumptions and outcomes for each component of the project. In addition, service agreements between each of the partners have been established to identify partner contributions to WW.

Table 2 provides a generic time line in which to achieve the elements of the project plan, while Table 3 contains a comprehensive outline of the project by project stage, major tasks, governance structure and milestones to be achieved for the first three years of the project. Additional information on the project outline can be viewed at www.health.wa.gov.au/

Doing: relates to the implementation of each of the subprojects project plans in a timely manner in accordance with project timetabling to achieve stated objectives and deliverables.

woundswest The project plan also addressed a number of other vital project considerations such as: assumptions; exclusions; constraints; budgets; communication; and change or risk

Studying: has involved the reassessment of project processes and examination of the results or outputs or effect of each subproject on achievement of individual subproject or overall WW aims and objectives.

management, quality and clinical governance processes.

Project governance Good project governance is essential no matter how small

Acting: requires revision of project processes based on lessons learnt.

or large a project is. WW required a governance structure that would ensure the project was well designed, would meet agreed time lines, would remain within budget and

Yearly subproject reports identify significant milestones, activities to be completed and make recommendations for forthcoming activities. Towards the conclusion of the project, an evaluation of each subproject and WW as an integrated system will be completed and widely disseminated.

would be evaluated and reported on in accordance with WA Department of Health’s Clinical Governance Framework. Considerable discussion occurred around the issue of governance to ensure the above parameters would be catered

Project plan

for as well as ensuring governance was representative of:

Critical to the successful outcome of any project is the creation of a comprehensive project plan. A project plan establishes project frameworks and guides facilitation, implementation and control of a project through planned methodical processes.

WW’s partners; local leaders in wound management; public,

The WW project director was responsible for developing WW’s project plan, which was subsequently endorsed by the executive sponsors, WW Advisory Committee and working group chairpeople. The inaugural WW project director was

Steering Group (ESG), Advisory Council, project director,


private and residential aged care facilities inclusive of WA country health services; Indigenous communities; safety and quality organisations; and the WA community. The following structure incorporating executive sponsors, an Executive project team and survey, education, IT and data working groups, supported by project officers was agreed upon (Figure 1). 126




Table 1. WW Subproject Objectives.

Subproject

Objectives

A. Survey

To develop and use a sustainable audit methodology, inclusive of tools, protocols and data analysis to: • Determine the prevalence of all major wound categories in West Australian acute public health services at various time intervals and to explore similar opportunities in community and residential services and general medical practices. • Assess the competency of audit surveyors. • Facilitate the conduct of a pilot study to assess the efficacy of all audit methods, tools and processes. • Develop data management processes. • Facilitate analysis and reporting of valid and reliable prevalence data to inform strategic planning and clinical practice. • Investigate methods of auditing the implementation and effectiveness of evidence-based wound management. • Investigate methods for determining the cost implications of all wound categories.

B. Education

To inform health consumers, health professionals and the community and to assist health services to reduce preventable wounds and adverse wound management outcomes of all wound categories by: • Developing or modifying existing evidence-based guidelines for the prediction, prevention and treatment of all major wound categories (acute, burns, leg ulcers, malignant, pressure ulcers and skin tears and other wounds). • Establishing minimum competency levels for wound management, modelled on the evidence-based guidelines. • Developing a process for clinical support to registered and unlicensed health professionals using evidence-based guidelines, electronic consultation and digital imaging. • Developing information on wound prevention and management to health consumers and the community to enable informed decision-making and improve health outcomes. • Disseminating the material noted above in an online format.

C. Information technology

To develop and deploy a statewide wound imaging and documentation system to: • Provide an advanced digital wound imaging and documentation system to track and report wound healing rates. • Electronically document wound assessment, treatment provided and clinical outcomes. • Provide a system for electronic expert wound consultation. • Develop and support the information technology needs of the survey and education subprojects of the Project.

D. Data Repository

To establish a data repository to: • Investigate data requirements for each project component. • Identify the appropriate indicators and benchmarks required to monitor and manage the data collection. • Identify methods to collect, manage and analyse such data, including compliance with relevant WA Health information management data policies and legislation. • Advise and direct project officers in the identification, collection, management and analysis of such data. • Advise and assist project officers in the presentation and dissemination of such data. • Support the publication of article(s) on the results of these activities.


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Figure 1 WoundsWest Governance Structure Prentice JL, Strachan V, Carville K, Santamaria N, Elmes R & Della P


Figure 1. WW Governance Structure

Executive Steering Group Executive Director Public Health & Ambulatory Care Chief Nurse & Midwifery Officer Project Director Chairs of Survey, Education, IT, Data Working Groups General Manager Silver Chain Head of School, School of Nursing & Midwifery Curtin University Representative Health Information Network

Project Team Project Director Chairs of Survey, Education, IT, Data Working Groups

Administration Support

Survey Working Group Project Director Chair Project Officer Nominees from: Tertiary Hospitals Epidemiology Academic & Nursing Research Silver Chain

Data Working Group Project Director Chair Project Officer Nominees from: WA Safety & Quality Council Health Information Network Silver Chain Nursing Association School of Nursing & Midwifery Curtin Tertiary Hospitals WA Country Health Service Chief Health Professions Office

Health providers Hospitals Community Residential

Education Working Group Project Director Chair Project Officer Nominees with expertise in wound management from: Tertiary Hospitals Podiatry Community Care Educational Units Media Unit Curtin University Specialty Units i.e. Burns Plastics Acute Surgery Leg Ulcer Clinics Paediatrics General Practice Stomal Therapy

Advisory Committee Executive Sponsors Project Director Chairs of Survey, Education, IT, Data Working Groups Nominees from: Silver Chain Nursing Association School of Nursing & Midwifery Curtin University Health Information Network WA Safety & Quality Council WA Health Consumers Council Royal Perth Hospital Burns Unit Chief Health Professions Office University of Western Australia’s School of Surgery and Pathology General Practice State Area Directors of Nursing WA Country Health Service WA Aged Care Sector WA Acute Private Sector Australian Council of Nursing Deans

IT Working Group Project Director Chair Project Officer Nominees from: Health Information Network Silver Chain Nursing Association Tertiary Hospitals

IT Project Officer

Education Project Team Project Director Chair Project Officers x 3

Wound Consultant Team WoundsWest Consultants x 2

13 Wound Practice and Research

128




Table 2. Generic Time line WW Project Year 1-3.

Component

Year 1 (2007)

Year 2 (2008)

Year 3 (2009)

Survey

Baseline measurement Pilot & statewide survey

2nd statewide survey

3rd statewide survey

Education

Develop & implement evidence-based guidelines, clinical decision support algorithms & patient education. Education & competency assessment.

Information Technology

WW server Imaging system design & trial

Data

Develop platform and processes to host WW data

Fully implement WWt IT Commence roll-out to sites

Roll-out to remaining sites

ESG

WW advisory committee

Membership of the ESG is composed of the executive

The functions of the WW Advisory Committee, an

director of Public Health and Ambulatory Care North

interdisciplinary committee of clinical experts, directors of

Metropolitan Area Health Service and the Chief Nurse and

nursing, university deans, other health sector and community

Midwifery Officer, who function as executive sponsors on

representatives are to:

behalf of WA Health. Other members are the project director,

• Provide governance to the project and specifically to advise

representatives of Silver Chain and Curtin University as WW

the survey, education, IT and data working groups.

partners and chairpersons of the survey, education, IT and

• Provide a forum for collaboration and cooperation

data working groups. Other members can be seconded as

between all health professionals and health consumers

required.

involved in the project.

The role of the ESG is to oversee and provide strategic

• Facilitate collaboration between research, education,

direction to the project inclusive of, but not limited to:

clinical practice and health promotion in relation to the project.

• Strategic decision-making and facilitation of the delivery of specific project tasks where required.

The Advisory Committee meets quarterly and is accountable to the WA Director General of Health through the Chief

• Endorsing documents, products and recommendations

Nursing and Midwifery Officer.

from the project team related to key stages of the project.

Project director

• Managing processes within and between the Department of Health, the ESG, the Advisory Committee and the

The project director controls all aspects of the project on a day

Director General and the WA Minister for Health.

to day basis from conception to finalisation and evaluation of the project and, is responsible for milestone reports, project

• Identifying potential risks or barriers to the development

deliverables, staffing and budget accountability.

and implementation of the project.

Project team

• Communicating the progress of the project to the broader

The project team, which meets fortnightly, comprises the

community.

project director and chairpeople of the working groups. Overarching responsibilities of the project team are the

The ESG is accountable to the WA Director General of Health

provision of:

through the Chief Nursing & Midwifery Officer and to the Area Chief Executive North Metropolitan Area Health Service

• Expert advice and recommendations on the project on a

through the Area Executive Director Ambulatory Care.


regular basis to the ESG and Advisory Committee. 129




• A forum for collaboration and cooperation between all

Working group membership was interdisciplinary broadly

subproject working groups (survey, education, IT and

representative of clinicians, academics, researchers, health

data).

informatics and epidemiologists.

• Opportunities for consultation, communication and

The function and outputs of the survey and education

engagement with internal and external stakeholders to

working groups are highlighted in other articles within this

develop and achieve the best possible outcomes for the

issue of the journal.

project.

WW advisory service

Subproject working groups

A subcomponent of the IT process was the establishment of

Working groups were convened to oversee the design,

the WW Advisory Service (WWAS). The service, manned by

planning, implementation and evaluation of the survey,

consultants with expertise in wound management, would

education, IT and data repository subprojects and to provide

facilitate electronic referral for advice on wound management

expert interdisciplinary advice to the project team, ESG and

from WA health staff. Currently the WWAS is being piloted

Advisory Committee. Each working group has an appointed

within six WA country health services. Staff in these services

chairperson, who works closely with the project director and

can access the WWAS by dialling 1300 WOUNDS, which

assigned project officers to facilitate the daily work processes

routes the call to a call centre hosted by Silver Chain. Access

of each subproject (Figure 1). All working groups have

can also be gained through the WW website. The purpose

formalised terms of reference and are responsible to the ESG.

of the pilot is to test internal functionality of the service.

Table 3. Project overview: Years 1-3 by stage, major tasks, governance and milestones achieved to date.

Stage

Major tasks & milestones

Completed by

Year 1

(note – project year is November to October)

Appoint director

Establish Advisory Committee

Launch project

1

A. Pilot wound prevalence survey.

B. Education planning and priority setting.

C. Scoping and development of technical specifications for IT needs.

2

A. Review of pilot survey data and methodology.

B. Development of educational material for surveyors.

B. Recruitment of education project officers.

3

A. Statewide wound prevalence survey 1.

B. Development of educational material for core wound module.

C. Development of detailed IT business model & technical specifications.

Aug 2007

4

A. Analysis and reporting of survey 1 data.

Sep 2007

A. Investigate methods for determining cost implications of prevention and

B. Roll-out of core wound education module.

B. Development and roll-out of educational material for wound categories 1 & 2 and

C. Development of recommendations for end-user devices.

C. Contract with IT vendor in place.

C. Commence development of wound imaging and remote referral software modification.

Nov 2006

Mar 2007

Apr 2007

Jun 2007

management of wound categories. Oct 2007

commence development of educational material for wound categories 3 & 4.


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Table 3 (cont.). Project overview: Years 1-3 by stage, major tasks, governance and milestones achieved to date. Year 2 5

A. Development of recommendations for other health sector data collection

A. Investigate methods to audit implementation and effectiveness of

B. Recruitment and associated process development of WW

C. Purchase and commissioning of WW server.

Jan 2008

C. Limited trial of wound imaging and documentation remote referral software.

Mar 2008

6

A. Statewide prevalence survey 2.

May 2008

B. Roll-out of educational material for wound categories 3 & 4 and development of

B. Induction, training and trial of WWCT process.

C. Review trial & plan for initial roll-out of wound imaging and documentation

(community & residential).

Dec 2007

evidence-based wound management. wound consultant team (WWCT).

educational material for wound categories 5 & 6.

remote expert referral system.

C. Commencement phase 1 roll-out of wound imaging and documentation

7


B. Roll-out of educational material for wound categories 5 & 6.

B. Roll-out of WWCT process.

C. Review initial roll-out and plan for Phase 2 roll-out of wound imaging and

Jun 2008

remote expert referral system. Sep 2008

Development of education materials for wound categories 7 & 8.

documentation remote expert referral system.

D. Investigate data repository.

Year 3 8

A. Statewide prevalence survey 3.

B. Roll-out of educational material for wound categories 7 & 8.

B. Review and refine WWCT process.

C. Complete phase 3 roll-out of wound imaging and documentation remote expert referral system.

C. Development of recommendations for other sector roll-out (community & residential).

9


B. Evaluate WWCT process and development of recommendations for

May 2009

Sep 2009

maintenance/ongoing programme.

C. Evaluate wound imaging and documentation remote expert referral system and

development of recommendations for maintenance/ongoing programme including usage data.

10

Finalisation and handover of project deliverables and/or ongoing processes

to maintenance teams/departments.


Oct 2012

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the implementation of evidence-based wound management protocols are adopted universally.

Evaluation of wound healing outcomes will be the subject of a larger longitudinal study should the Service be implemented across WA Health.

Effective clinical governance in wound management has been shown to reduce variations in clinical practice, reduce health costs and improve wound healing outcomes and the quality of life of patients with wounds.

Project outcomes WW has successfully met many of its project deliverables as identified in Table 3. Three statewide wound prevalence surveys have been undertaken. The online education programme is well advanced, with the launch of a core wound module and modules for pressure ulcers, burns, foot ulcers and skin tears. Planning for other education modules is well advanced. Advances have also been made with respect to the IT subproject, with the piloting of wound imaging processes, the WWAS and development of IT procurement plans. The data working group is developing objectives to govern management of the data repository.

Acknowledgements WW wishes to acknowledge and Curtin University staff, and working group members successful development and project.

Special thanks to Mrs Veronica Strachan, project director, November 2006 to December 2008 for her exceptional project management skills.

Unintended project outcomes relate to: requests to use the prevalence survey methodology; requests for didactic education and linkage to WW education programme by other sectors internal and external to WA; and the receipt of $2.5m in federal Pathways funding to implement a statewide mattress replacement programme to name a few.

References

Following a collaborative research project with Murdoch University that identified deficits in Aboriginal health workers' (AHWs) knowledge and clinical practice of wounds, WW has embarked on a project to develop didactic and online education modules on wound assessment and management for unlicensed AHWs. Both programmes are aimed at improving the knowledge, skill, competence and confidence of AHWs in providing care to patients with wounds. The programmes developed will be trialled in registered training organisations, providing education to prospective AHWs.

1.

Young J et al. A study on the incidence of pressure ulcers in the acute orthopaedic setting. Primary Intention 2000; 8(4):142-147.

2.

Morey P & Porock D. A quality improvement survey of pressure ulcers at a tertiary teaching hospital. Primary Intention 1997; 5(2):18-25.

3.

McGowan S, Hensley L & Maddocks J. Monitoring the occurrence of pressure ulcers in a teaching hospital: A quality improvement project. Primary Intention 1996; 4(1):9-16.

4.

Young J et al. Risk factors associated with pressure ulcer development at a major western Australian teaching hospital from 1998 to 2000: Secondary data analysis. J Wound Ostomy Continence Nurs 2002; 29(5):234-41.

5.

Baker S & Stacey M, Epidemiology of chronic leg ulcers in Australia. ANZ J Surg 1994; 64:258-261.

6.

Rea SM & Wood F. Minor burn injuries in adults presenting to regional burns units in Western Australia: A prospective descriptional study. Burns 2005; 31(5):1035-40.

7.

Everett S & Powell T. Skin tears – the underestimated wound. Primary Intention 1994; 2(1):28-30.

8.

Prentice JL, Stacey MC & Lewin G. An Australian model for conducting pressure ulcer prevalence surveys. Primary Intention 2003; 11(2):87-88,9091,93-96,98-100,102-109.

9.

Victorian Quality Council. VQC Statewide PUPPS Report – 2003: Pressure ulcer point prevalence survey. Melbourne, Australia: Department of Human Services, 2004.

Summary WW is a large and dynamic project. WW’s ability to meet its identified objectives to date is the result of many factors; primarily adherence to a comprehensive project plan, strong executive and partner support, clear roles and responsibilities for all project groups, enthusiasm and dedication of all project staff and an understanding of known project risks and assumptions. Another fundamental factor has been the outstanding support of WW by WA clinicians and health services.

10. Victorian Quality Council. VQC Statewide PUPPS Report – 2004: Pressure ulcer point prevalence survey. Melbourne, Australia: Department of Human Services, 2005. 11. Victorian Quality Council. Pressure ulcer basics. A guide to pressure ulcer prevention and management from the Victorian Quality Council. Melbourne, Australia: Department of Human Services. 2005 [Accessed 12 December 2005]; Available from: www.health.vic.gov.au/pressureulcers 12. Santamaria N et al. Clinical IT in aged care product trial. Final evaluation report for the pressure ulcer research, intervention, management and evaluation (PRIME) system in aged care trial. Canberra, ACT: Department of Health and Ageing, 2005.

The need for good clinical governance of wounds within health systems will continue to grow as demands on health services and finite resources increase. WW is providing WA Health with concrete strategies to reduce the burden of wounds within WA. Health executives and clinicians need to avail themselves of these resources and ensure


all WA Health, Silver Chain the WW Advisory Council who have contributed to the implementation of the WW

13. Santamaria N et al. The effectiveness of digital imaging and remote expert wound consultation on healing rates in chronic lower leg ulcers in the Kimberley region of Western Australia. Primary Intention, 2004; 12(2): 62-64,66-68,70. 14. Edwards W. Deming Institute. 2009 [cited April 2009]; Available from: http://www.deming.org

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